The withdrawal from oncogenetic counselling and testing for hereditary and familial breast and ovarian cancer. A descriptive study of an Italian sample

<p>Abstract</p> <p>Background</p> <p>Oncogenetic counselling is seldom followed through, even when individuals are eligible according to the test criteria. The basic variables which influence the decision to undergo the genetic counselling process are: risk perception, expected benefit or limitations of genetic testing, general psychological distress or cancer-specific distress, lack of trust in one's emotional reactions when faced with negative events, expected level of family support and communications within the family. The aim of this study was to describe the psychosocial variables of an Italian sample that forgoes genetic counselling.</p> <p>Methods</p> <p>From May 2002 to December 2006 a psychological questionnaire was sent out to one hundred and six subjects, who freely requested a first genetic informative consultation, and never asked to have a second visit and the family tree drawn up in order to inquire about their eligibility for genetic testing. Statistical analysis was performed by Pearson chi-square test, t-test and Spearman RHO coefficient.</p> <p>Results</p> <p>The survey presents a lack of emotional cohesion and structured roles and rules within the family system and a positive correlation between the number of children, anxiety and risk perception. The main reasons for giving up on counselling were a sense that testing was a waste of time and the inability to emotionally handle the negative consequences of the test outcome. The subjects who maintained that test and an early diagnosis were a "waste of time" experienced more anxiety.</p> <p>Conclusion</p> <p>The study revealed the importance to ac knowledging the whole persona and their family system as well as provide information highlighting usefulness of early diagnosis.</p

Separatrix splitting at a Hamiltonian 02iω0^2 i\omega bifurcation

We discuss the splitting of a separatrix in a generic unfolding of a degenerate equilibrium in a Hamiltonian system with two degrees of freedom. We assume that the unperturbed fixed point has two purely imaginary eigenvalues and a double zero one. It is well known that an one-parametric unfolding of the corresponding Hamiltonian can be described by an integrable normal form. The normal form has a normally elliptic invariant manifold of dimension two. On this manifold, the truncated normal form has a separatrix loop. This loop shrinks to a point when the unfolding parameter vanishes. Unlike the normal form, in the original system the stable and unstable trajectories of the equilibrium do not coincide in general. The splitting of this loop is exponentially small compared to the small parameter. This phenomenon implies non-existence of single-round homoclinic orbits and divergence of series in the normal form theory. We derive an asymptotic expression for the separatrix splitting. We also discuss relations with behaviour of analytic continuation of the system in a complex neighbourhood of the equilibrium

Mutually Penetrating Motion of Self-Organized 2D Patterns of Soliton-Like Structures

Results of numerical simulations of a recently derived most general dissipative-dispersive PDE describing evolution of a film flowing down an inclined plane are presented. They indicate that a novel complex type of spatiotemporal patterns can exist for strange attractors of nonequilibrium systems. It is suggested that real-life experiments satisfying the validity conditions of the theory are possible: the required sufficiently viscous liquids are readily available.Comment: minor corrections, 4 pages, LaTeX, 6 figures, mpeg simulations available upon or reques

Singularities of bi-Hamiltonian systems

We study the relationship between singularities of bi-Hamiltonian systems and algebraic properties of compatible Poisson brackets. As the main tool, we introduce the notion of linearization of a Poisson pencil. From the algebraic viewpoint, a linearized Poisson pencil can be understood as a Lie algebra with a fixed 2-cocycle. In terms of such linearizations, we give a criterion for non-degeneracy of singular points of bi-Hamiltonian systems and describe their types

A new method for tracking of motor skill learning through practical application of Fitts’ law

This article is made available through the Brunel Open Access Publishing Fund.A novel upper limb motor skill measure, task productivity rate (TPR) was developed integrating speed and spatial error, delivered by a practical motor skill rehabilitation task (MSRT). This prototype task involved placement of 5 short pegs horizontally on a spatially configured rail array. The stability of TPR was tested on 18 healthy right-handed adults (10 women, 8 men, median age 29 years) in a prospective single-session quantitative within-subjects study design. Manipulations of movement rate 10% faster and slower relative to normative states did not significantly affect TPR, F(1.387, 25.009) = 2.465, p = .121. A significant linear association between completion time and error was highest during the normative state condition (Pearson's r = .455, p < .05). Findings provided evidence that improvements in TPR over time reflected motor learning with possible changes in coregulation behavior underlying practice under different conditions. These findings extend Fitts’ law theory to tracking of practical motor skill using a dexterity task, which could have potential clinical applications in rehabilitation

A micro costing of NHS cancer genetic services

This paper presents the first full micro costing of a commonly used cancer genetic counselling and testing protocol used in the UK. Costs were estimated for the Cardiff clinic of the Cancer Genetics Service in Wales by issuing a questionnaire to all staff, conducting an audit of clinic rooms and equipment and obtaining gross unit costs from the finance department. A total of 22 distinct event pathways were identified for patients at risk of developing breast, ovarian, breast and ovarian or colorectal cancer. The mean cost per patient were £97–£151 for patients at moderate risk, £975–£3072 for patients at high risk of developing colorectal cancer and £675–£2909 for patients at high risk of developing breast or ovarian cancer. The most expensive element of cancer genetic services was labour. Labour costs were dependent upon the amount of labour, staff grade, number of counsellors used and the proportion of staff time devoted to indirect patient contact. With the growing demand for cancer genetic services and the growing number of national and regional cancer genetic centers, there is a need for the different protocols being used to be thoroughly evaluated in terms of costs and outcomes

Influences of polymorphic variants of DRD2 and SLC6A3 genes, and their combinations on smoking in Polish population

<p>Abstract</p> <p>Background</p> <p>Polymorphisms in dopaminergic genes may influence cigarette smoking by their potential impact on dopamine reward pathway function. <it>A1 </it>allele of <it>DRD2 </it>gene is associated with a reduced dopamine D2 receptor density, and it has been hypothesised that <it>A1 </it>carriers are more vulnerable to smoking. In turn, the 9-repeat allele of dopamine transporter gene (<it>SLC6A3</it>) has been associated with a substantial reduction in dopamine transporter, what might result in the higher level of dopamine in the synaptic cleft, and thereby protective role of this allele from smoking. In the present study we investigated whether polymorphic variants of <it>DRD2 </it>and <it>SLC6A3 </it>genes and their combinations are associated with the smoking habit in the Polish population.</p> <p>Methods</p> <p>Genotyping for <it>Taq</it>I<it>A </it>polymorphism of <it>DRD2 </it>and <it>SLC6A3 </it>VNTR polymorphism was performed in 150 ever-smokers and 158 never-smokers. The association between the smoking status and smoking phenotypes (related to the number of cigarettes smoked daily and age of starting regular smoking), and genotype/genotype combinations was expressed by ORs together with 95% CI. Alpha level of 0.05, with Bonferroni correction whenever appropriate, was used for statistical significance.</p> <p>Results</p> <p>At the used alpha levels no association between <it>DRD2 </it>and <it>SLC6A</it>3 genotypes and smoking status was found. However, <it>A1 </it>allele carriers reported longer abstinence periods on quitting attempts than non-carriers (p = 0.049). The ORs for heavier smoking were 0.38 (0.17-0.88), p = 0.023, and 0.39 (0.17-0.88), p = 0.021 in carriers compared to non-carriers of <it>A1 </it>or <it>*9 </it>allele, respectively, and the OR for this smoking phenotype was 8.68 (2.47-30.46), p = 0.0005 for the <it>A1</it>-/<it>9</it>- genotype combination, relatively to the <it>A1</it>+/<it>9</it>+. Carriers of <it>*9 </it>allele of <it>SLC6A3 </it>had over twice a lower risk to start smoking before the age of 20 years compared to non-carriers (sex-adjusted OR = 0.44; 95% CI: 0.22-0.89; p = 0.0017), and subjects with <it>A1-/9- </it>genotype combination had a higher risk for staring regular smoking before the age of 20 years in comparison to subjects with <it>A1+/9+ </it>genotype combination (sex-adjusted OR = 3.79; 95% CI:1.03-13.90; p = 0.003).</p> <p>Conclusion</p> <p>Polymorphic variants of <it>DRD2 </it>and <it>SLC6A3 </it>genes may influence some aspects of the smoking behavior, including age of starting regular smoking, the level of cigarette consumption, and periods of abstinence. Further large sample studies are needed to verify this hypothesis.</p

An Australian longitudinal pilot study examining health determinants of cardiac outcomes 12 months post percutaneous coronary intervention

Background Percutaneous coronary intervention (PCI) is a very common revascularisation procedure for coronary artery disease (CAD). The purpose of this study was to evaluate cardiac outcomes, health related quality of life (HRQoL), resilience and adherence behaviours in patients who have undergone a PCI at two time points (6 and 12 months) following their procedure. Methods A longitudinal pilot study was conducted to observe the cardiac outcomes across a cohort of patients who had undergone a percutaneous coronary intervention (PCI). Participants who had undergone PCI 6 months prior were invited. Those participants who met the inclusion criteria and provided consent then completed a telephone survey (time point 1). These participants were then contacted 6 months later (i.e. 12 months post-intervention, time point 2) and the measures were repeated. Results All patients (n = 51) were recorded as being alive at time point 1. The multiple model indicated that controlling for other factors, gender was significantly associated with a linear combination of outcome measures (p = 0.004). The effect was moderate in magnitude (partial-η2 = 0.303), where males performed significantly better than females 6 months after the PCI procedure physically and with mood. Follow-up univariate ANOVAs indicated that gender differences were grounded in the scale measuring depression (PHQ9) (p = 0.005) and the physical component score of the short form measuring HRQoL (SF12-PCS) (p = 0.003). Thirteen patients were lost to follow-up between time points 1 and 2. One patient was confirmed to have passed away. The pattern of correlations between outcome measures at time point 2 revealed statistically significant negative correlation between the PHQ instrument and the resilience scale (CD-RISC) (r = -0.611; p < 0.001); and the physical component score of the SF-12 instrument (r = -0.437; p = 0.054). Conclusions Men were performing better than women in the 6 months post-PCI, particularly in the areas of mood (depression) and physical health. This pilot results indicate gender-sensitive practices are recommended particularly up to 6 months post-PCI. Any gender differences observed at 6 month appear to disappear at 12 months post-PCI. Further research into the management of mood particularly for women post-PCI is warranted. A more detailed inquiry related to access/attendance to secondary prevention is also warranted

Modulation of Localized States in Electroconvection

We report on the effects of temporal modulation of the driving force on a particular class of localized states, known as worms, that have been observed in electroconvection in nematic liquid crystals. The worms consist of the superposition of traveling waves and have been observed to have unique, small widths, but to vary in length. The transition from the pure conduction state to worms occurs via a backward bifurcation. A possible explanation of the formation of the worms has been given in terms of coupled amplitude equations. Because the worms consist of the superposition of traveling waves, temporal modulation of the control parameter is a useful probe of the dynamics of the system. We observe that temporal modulation increases the average length of the worms and stabilizes worms below the transition point in the absence of modulation.Comment: 4 pages, 4 figure